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Metabolic Positron Emission Tomography Imaging in Cancer Detection and Therapy Response
Open accessAbstract
Positron emission tomography (PET) is a noninvasive imaging technique that provides a functional or metabolic assessment of normal tissue or disease conditions. Fluorine 18-fluorodeoxyglucose PET imaging (FDG-PET) is widely used clinically for tumor imaging due to increased glucose metabolism in most types of tumors, and has been shown to improve the diagnosis and subsequent treatment of cancers. We review its use in cancer diagnosis, staging, restaging, and assessment of response to treatment. In addition, other metabolic PET imaging agents in pre-clinical research or clinical trial stages of development are discussed, including amino acid analogs based on increased protein synthesis, and choline, which is based on increased membrane lipid synthesis. Amino acid analogs and choline are more specific to tumor cells than FDG, so they play an important role in differentiating cancers from benign conditions and in the diagnosis of cancers with low FDG uptake or high background FDG uptake. For decades, researchers have shown that tumors display altered metabolic profiles with elevated uptake of glucose, amino acids, and lipids. This can be used for cancer diagnosis and monitoring of the therapeutic response with excellent signal-to-noise ratios.
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“Despite challenges associated with targeting glucose metabolism directly, glucose uptake by cancer cells has been successfully exploited in patients through the use of the fluoro-deoxyglucose positron-emission-tomography (FDG-PET) imaging to stage cancers and assess response to therapy (d’Amico, 2015; Farwell et al., 2014; Zhu et al., 2011).”
From Targeting Metabolism for Cancer Therapy (2017) · cites this paper as Zhu et al., 2011
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Positron Emission Tomography (PET)
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Voltage-Dependent Anion Channels and Tubulin: Bioenergetic Controllers in Cancer Cells
Maldonado, E. N., DeHart, D. N., & Lemasters, J. J. (2017) · Biological and medical physics, biomedical engineering · doi:10.1007/978-3-319-55539-3_5 · Cited by 1
Unexpected focal fluorodeoxyglucose uptake in main organs; pass through or pass by?
Lee, H., & Hwang, K.-H. (2024) · World Journal of Clinical Cases · doi:10.12998/wjcc.v12.i11.1885 · Cited by 1
The Development and Evaluation of a Novel Highly Selective PET Radiotracer for Targeting BET BD1
Wang, Y., Wang, Y., Xu, Y., Kang, L., Tocci, D. R., & Wang, C. (2024) · Pharmaceuticals · doi:10.3390/ph17101289 · Cited by 1
“This precision is crucial for accurate PET imaging to ensure specificity to targeted tissues or functions [16].”
BackgroundCompact and cGMP-compliant automated synthesis of [18F]FSPG on the Trasis AllinOne™
Farooq, R., Gendron, T., Edwards, R. S., & Witney, T. H. (2025) · EJNMMI Radiopharmacy and Chemistry · doi:10.1186/s41181-024-00322-7 · Cited by 1
Vincenzi, M. D., Mori, M., Passoni, P., Tummineri, R., Slim, N., Midulla, M., Palazzo, G., Belardo, A., Spezi, E., Picchio, M., et al. (2025) · Cancers · doi:10.3390/cancers17061036 · Cited by 1
Carcinogenesis: An Alternative Hypothesis Comparing Mutagenic Versus Metabolic Models
Alhatem, A., Gagna, C. E., Lambert, M. W., Keenan, E., & Lambert, W. C. (2025) · Biology · doi:10.3390/biology14101314 · Cited by 1
“…observed that many cancers preferentially utilize the pentose phosphate pathway over the tricarboxylic acid (TCA) cycle for energy production [6–16], a metabolic shift now exploited in positron emission tomography (PET) imaging [17], in which metastatic cancer is identified radiographically [17].”
Brain networks involved in cancer treatment response: insights from 18F-FDG PET scans
Namías, M., Perovnik, M., Huff, D. T., Tinetti, C., Azar, M. E., Strašek, K., Hribernik, N., Reberšek, M., Studen, A., Bruno, G. L., et al. (2025) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ae0beb · Cited by 1
“Furthermore, 18 F-FDG PET is a standard tool in oncology, where it is routinely employed to assess tumor metabolism due to the elevated glucose uptake in cancer cells (Zhu et al 2011, Boellaard et al 2014).”
Suri, T. M., Goel, A., Khan, M. A., Tiwari, P., Mittal, S., Hadda, V., Madan, K., & Mohan, A. (2025) · Therapeutic Advances in Respiratory Disease · doi:10.1177/17534666251395432 · Cited by 1
Cancer detection: Screening tools and biomarker discoveries
Anas, M. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-33263-0.00007-3 · Cited by 1
Behzadi, S. T., Wider, J., Nano, J., Kiesl, S., Moser, R., Allwohn, L., Maier, S., Klein, E., Schmidt, G. P., Kiechle, M. B., et al. (2026) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2026.07.050 · Cited by 1
Prieto, E., Martí-Climent, J. M., Gómez, M., García‐Velloso, M. J., Valero, M., Garrastachu, P., Aristu, J., Alcázar, J. L., Torre, W., Hernández, J. L., et al. (2014) · Revista Española de Medicina Nuclear e Imagen Molecular (English Edition) · doi:10.1016/j.remnie.2014.01.007 · Cited by 1
Role of PET in Cancer Diagnosis
Treglia, G. (2013) · CRC Press eBooks · doi:10.1201/b16389-8 · Cited by 1
Incerti, E., Mapelli, P., & Picchio, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-42327-2_7 · Cited by 1
Application of Functional Molecular Imaging in Radiation Oncology
Naz, S., Krishna, M. C., & Mitchell, J. B. (2016) · Cancer drug discovery and develogment/Cancer drug discovery and development · doi:10.1007/978-3-319-40854-5_5 · Cited by 1
Pelak, M. J. (2016) · Cancer clinical trials · Cited by 1
Targeting metabolism: A potential strategy for hematological cancer therapy
Tang, X., Chen, F., Xie, L.-C., Liu, S., & Mai, H. (2022) · World Journal of Clinical Cases · doi:10.12998/wjcc.v10.i10.2990 · Cited by 1
Kuroshima, T., Kitagawa, Y., Sato, J., Watanabe, S., Asaka, T., Abe, T., Harada, H., Hirata, K., & Kuge, Y. (2024) · Odontology · doi:10.1007/s10266-024-00946-w · Cited by 1
“Positron emission tomography (PET) imaging allows clinicians to view and assess the metabolic activities of tumor cells, not the anatomical or structural changes in affected sites, by the uptake of radioactive tracers [3].”
InfluentialTransformation of Healthcare through Bioimaging and Bioinformatics
Singh, S., & Negi, K. (2024) · International Journal of Pharma Professional’s Research (IJPPR) · doi:10.69580/ijppr.15.2.2024.96-113 · Cited by 1
Bozkurt, M., Okutur, K., Aydın, K., Namal, E., Öztürk, A., Balcı, C., & DEMIR, G. (2012) · Oncology Letters · doi:10.3892/ol.2012.663 · Cited by 1
Role of PET/CT in Radiotherapy Treatment Planning
Picchio, M., Incerti, E., & Muzio, N. G. D. (2016) · Springer eBooks · doi:10.1007/978-3-319-40070-9_22 · Cited by 1
Incerti, E., Vanoli, E. G., Broggi, S., Gumina, C., Passoni, P., Slim, N., Fiorino, C., Reni, M., Mapelli, P., Cattaneo, M., et al. (2019) · Nuclear Medicine Communications · doi:10.1097/mnm.0000000000001065 · Cited by 1
Building Up the Diagnosis of Cardiac Device Infections: The Role of Imaging
Diemberger, I., Lorenzetti, S., & Bonfiglioli, R. (2020) · Springer eBooks · doi:10.1007/978-3-030-46255-0_5 · Cited by 1
Feng, K. M., Chen, Y., Chen, J., Lin, L., Tsai, W., & Chen, C. (2021) · Medicina · doi:10.3390/medicina57060539 · Cited by 1
“PET, which uses short-lived radioisotopes, such as fluorine-18 to label glucose, can detect malignancy and be used for staging, restaging, or monitoring treatment responses [17].”
BackgroundSun, L., Gai, Y., Li, Z., Zhang, X., Li, J., Ma, Y., Li, H., Barajas, R., & Zeng, D. (2021) · Advanced Therapeutics · doi:10.1002/adtp.202100110 · Cited by 1
Regulation of Glucose Transporters in Cancer Progression
Raj, S., Mishra, M. K., Harihar, S., Kumar, A., Roychoudhury, S., Kumar, A. J., Rathi, B., & Kumar, D. (2021) · Molecular and integrative toxicology · doi:10.1007/978-3-030-83446-3_9 · Cited by 1
Construction of Molecular Probes and Imaging Applications
Pham, W. N. (2022) · Springer eBooks · doi:10.1007/978-981-19-5739-0_6 · Cited by 1
Akolkar, D. B., Patil, D., Puranik, S., Puranik, S., Nandre, P. S., Sabale, K. R., Apurwa, S., Bodke, H., Shrivastava, N., Datta, V., et al. (2022) · medRxiv · doi:10.1101/2022.04.07.22273446 · Cited by 1
Multiple Bony Metastatic Lesions and Evaluation of Primary: Case Records of a Cancer Research Centre
Sundriyal, D., Shirsi, N., Gera, A., Bansal, S., Kotwal, S., & Dawar, R. (2015) · Indian Journal of Surgical Oncology · doi:10.1007/s13193-015-0394-z
“FDG , the most commonly used tracer in PET imaging shows variable physiological uptake by normal tissues (high in brown fat, heart, brain, kidneys and bladder), unusual tumour sites, infections, granulomatous diseases like tuberculosis, inflammatory conditions and in cases of hyperglycemia [9, 10].”
BackgroundClinical Implications of Breast Cancer
Tsiftsis, D.-A. D. (2013) · Springer eBooks · doi:10.1007/978-88-470-5385-4_49
“Early results from trials using new imaging agents like amino acid analogs and choline fair even better [4].”
Background
Metadata
- Authors
- Zhu, A., Lee, D., & Shim, H.
- Affiliations
- Emory University (US)
- Corresponding author
- Shim, Hyunsuk
- Venue
- Seminars in Oncology
- Publisher
- Elsevier BV
- Published
- 2011-02
- Volume
- 38
- Issue
- 1
- Pages
- 55-69
- ISSN
- 0093-7754 (ISSN-L)
- PMC
- PMC3075495
- OpenAlex
- W1982620463
- Cited by
- 368
- References
- 121
- Citations by year
- 2026: 16 · 2025: 31 · 2024: 35 · 2023: 24 · 2022: 35 · 2021: 33 · 2020: 38 · 2019: 36 · 2018: 30 · 2017: 26 · 2016: 17 · 2015: 13 · 2014: 11 · 2013: 11 · 2012: 10
- FWCI
- 8.32
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Seminars in Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (P50CA128301)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Cancer, Hypoxia, and Metabolism
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
- Keywords
- FDG-PET, cancer diagnosis, tumor staging, restaging, treatment response assessment, amino acid analogs, choline PET, tumor glucose metabolism, tumor lipid metabolism, tumor imaging agents
- MeSH terms
- Choline, Humans, Neoplasm Staging, Neoplasms, Sensitivity and Specificity, Tyrosine, Drug Monitoring, Radiopharmaceuticals, Fluorodeoxyglucose F18, Positron-Emission Tomography, Molecular Imaging
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